Bleeding on the IUD
In the United States, 5.3% women choose to use an IUD. But did you know that IUDs can have different effects on your period quality and quantity?
If you are considering getting an IUD and wondering what your period will be like after it’s inserted, here is what you should know.
What Is An IUD?
An intrauterine device (IUD) is a type of female contraceptive that is inserted through the vagina into the uterus. The most common types of IUDs are T-shaped and plastic, and contain either a synthetic progesterone or copper. IUDs provide long-term contraceptive protection for 3 to 10 years (or more), depending on the type. IUDs can affect your period in several different ways, depending on the type.
Here’s how they differ:
1. Hormone-releasing IUD
The hormone-releasing IUD contains a synthetic version of progesterone called progestin, which is continuously released at a low daily dose. Progestin works to prevent pregnancy in several ways: it thickens cervical fluid to prevent sperm from travelling into the uterus, thins the uterine lining, and also sometimes suppresses ovulation. Ovulation suppression depends on the dose of progestin released from the IUD. For example, IUDs with a lower progestin dose are less likely to suppress ovulation in comparison IUDs with a higher progestin dose. The rate of ovulation suppression also seems to decrease the longer the IUD is worn. The presence of the IUD within the uterus causes an irritation, creating an inflammatory reaction in the uterus that makes it inhospitable to both egg and sperm. A single hormonal IUD can last for 3 to 5 years, depending on the type.
How will my period change on the hormonal IUD?
Since the hormonal IUD thins the uterine lining and may inhibit ovulation (the release of an egg from the ovary) your period is likely to be different. Two out of three hormonal IUD users experience lighter bleeding within six months. In studies, people using a hormonal-IUD had a decreased amount of blood flow to the uterus and thinner endometrial lining thickness, in comparison to people who were using a copper IUD or who were not using hormonal contraceptives.
Some people report spotting or unscheduled bleeding between periods. Many people using hormonal IUDs also report a decrease in cramping. You might stop getting your period at all.
2. Copper intrauterine device (IUDs)
The copper IUD is a device that is inserted into the uterus by a medical professional. Like the hormonal-IUD, the copper IUD also causes physical irritation, creating an inflammatory reaction in the uterus. The copper IUD does not contain hormones and therefore does not exert any changes to your hormone profile. People using copper IUDs will still ovulate and have a menstrual period. A single copper IUD can protect against pregnancy for up to 10 years, depending on brand.
How will my period change on the copper IUD?
The copper IUD does not prevent ovulation, so you will still experience a menstrual period. But it is common for people to experience heavier or longer periods, as well as unscheduled spotting or bleeding, during the first few months of use. Heavier menstrual flow with copper IUDs might be caused by vascular changes, which regulate blood flow to the uterus. In studies, these blood flow changes were found to be greater in people using a copper IUD with heavy menstrual periods compared with copper-IUD users with normal menstrual bleeding. More research is needed here.
Upon starting the copper IUD, 6 in 10 people reported increased cramping and 7 in 10 reported increased bleeding during the first three months of use. These symptoms have been shown to decrease over time in most people. For people who do experience increased menstrual bleeding, there is an increased risk of developing an anemia due to excessive blood loss. Among copper IUD users with increased irregular bleeding, there may also be an increase in prevalence of bacterial vaginosis (a bacterial overgrowth in the vagina), but more research is needed.
With both the copper IUD and hormonal IUD, there is an increased chance of spotting or bleeding for a few months after insertion.
Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD009590.
Centres for disease control and prevention. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. Morbidity and Mortality Weekly Report. 2016;65(4):7–14.
Diedrich JT, Desai S, Zhao Q, Secura G, Madden T, Peipert JF. Association of Short-term Bleeding and Cramping Patterns with Long-Acting Reversible Contraceptive Method Satisfaction. Am J Obstet Gynecol. 2015;212(1):50.e1–50.e8.
Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009 May;79(5):356–362.
Jiménez MF, Vetori D, Fagundes PA, de Freitas FM, Cunha-Filho JS. Subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects (levonorgestrel intrauterine system and copper intrauterine device). Contraception. 2008 Oct;78(4):324-7.
Kailasam C, Cahill D. Review of the safety, efficacy and patient acceptability of the levonorgestrel-releasing intrauterine system. Patient Prefer Adherence. 2008;2:293-302.
Madden T, Grentzer JM, Secura GM, Allsworth JE, Peipert JF. Risk of Bacterial Vaginosis in Users of the Intrauterine Device: A Longitudinal Study. Sexually Transmitted Diseases. 2012;39(3):217-222.
Mirena monograph. Bayer. Whippany; [revision date: 2017 Jun; cited: 2017 Dec6]. Pp 20. Available from: https://labeling.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf
Momtaz M, Zayed M, Raashid K, Idriss O. Doppler study of the uterine artery in patients using intrauterine contraceptive device. Ultrasound Obstet Gynecol 1994;4:231–5.
Ortiz ME, Croxatto HB: Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 75:S16, 2007.
Product monograph Pr Kyleena® levonorgestrel-releasing intrauterine system (19.5 mg). Bayer. Mississauga: [revision date: 2017 Sep 28; cited: 2017 Dec 6]. Pp 30,31. Available from: http://omr.bayer.ca/omr/online/kyleena-pm-en.pdf
United Nations. World Contraceptive Use 2011. Accessed Oct 19 2017. http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm